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<title>Ski-Doo, Can-AM, Mercury, Lowe, HarberCraft - GIBBONS MOTOR TOYS</title>
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<meta name="description" content="Gibbons Motor Toys has locations in Gibbons, AB & Salmon Arm, BC. Specializing in sales and service of marine products, snowmobiles, and ATVs from Ski-Doo, Can-Am, Mercury, and Harbercraft." />
<meta name="keywords" content="atv sales, atv dealer, boat dealer, boat sales, mercury motors, outboard motors, four-wheeler, 4 wheeler, snowmobiles, sleds, sled racks, atv parts, atv service alberta, atv service shop, fix atv, fix boat, boat parts, razor, razer, commander, kingfisher, harborcraft boats, gibsons motor toys, Ski-Doo, Can-AM, Mercury, Lowe, HarberCraft, marine sales, fish boat, aluminum boat" /> 
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	<h1 >SERVICE REQUEST FORM</h1><br />


			


<span class="textmed">Please submit the form below and we will respond to you quickly, all fields are required </span>
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<br />



<form action="service_save.php" method="POST" id="apply_online">
<input type="hidden" name="recipient" value="sendHere">
<input type="hidden" name="subject" value="Gibbons Motor Toys Service Request Form Results">
<input type="hidden" name="required" value="realname,last name,address,city,Province,Postal Code,Phone,email,Service Date,Service Requested">
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<input type="hidden" name="redirect" value="http://http://www.gibbonsmotortoys.com/thankyou.php">

<?php
if($_REQUEST["msg"]=="success")
{
?>
<div id="green-cont" style="display:block;"><img src="images/Childish-Thumb-Up-32.png" alt="" align="left" /> <p>Thank You for contacting Us! You will get an email from us very soon.</p></div>
<?php
}
?>
          <table width="659" border="0" cellspacing="0" cellpadding="3" align="left">
          
          
            <tr> 
              <td width="130"> 
                <div align="left"><strong>First Name <span style="color:#F00;">*</span>:</strong>&nbsp;</div>
              </td>
              <td width="500"><div align="left"> 
                <input type="text" name="realname" size="46" value="">
               </div>
</td>
            </tr>
            <tr> 
              <td width="130"> 
                <div align="left"><strong>Last Name <span style="color:#F00;">*</span>:</strong>&nbsp;</div>
              </td>
              <td width="500"><div align="left"> 
                <input type="text" name="lastname" size="46" value="">
               </div>
</td>
            </tr>
            
            
            
            <tr> 
              <td width="130"> 
                <div align="left"><strong>Address <span style="color:#F00;">*</span>:</strong>&nbsp;</div>
              </td>
              <td width="500"><div align="left"> 
               <input type="text" name="address" size="46" value="">
                </div>
</td>
            </tr>
            <tr> 
              <td width="130"> 
                <div align="left"><strong>City <span style="color:#F00;">*</span>:</strong>&nbsp;</div>
              </td>
              <td width="500"><div align="left"> 
               <input type="text" name="city" size="46" value="">
                </div>
</td>
            </tr>
            
            <tr> 
              <td width="130"> 
                <div align="left"><strong>Province <span style="color:#F00;">*</span>:</strong>&nbsp;</div>
              </td>
              <td width="500"><div align="left"> 
              <select name="Province">
	<option selected="selected" value="">-Select A Province-</option>
	<option value="Alberta">Alberta</option>

	<option value="British Columbia">British Columbia</option>
	<option value="Manitoba">Manitoba</option>
	<option value="New Brunswick">New Brunswick</option>
	<option value="Newfoundland &amp; Labrador">Newfoundland &amp; Labrador</option>
	<option value="Northwest Territories">Northwest Territories</option>

	<option value="Nova Scotia">Nova Scotia</option>
	<option value="Nunavut Territory">Nunavut Territory</option>
	<option value="Ontario">Ontario</option>
	<option value="Prince Edward Island">Prince Edward Island</option>
	<option value="Quebec">Quebec</option>
	<option value="Saskatchewan">Saskatchewan</option>

	<option value="Yukon Territory">Yukon Territory</option>
    <option value="Outside Canada">Outside Canada</option>

</select>
                </div>
</td>
            </tr>
            
            <tr> 
              <td width="130"> 
                <div align="left"><strong>Postal Code <span style="color:#F00;">*</span>:</strong>:&nbsp;</div>
              </td>
              <td width="500"><div align="left"> 
               <input type="text" name="PostalCode" size="46" value="">
                </div>
</td>
            </tr>
            
            <tr> 
              <td width="130"> 
                <div align="left"><strong>Phone <span style="color:#F00;">*</span>:</strong>&nbsp;</div>
              </td>
              <td width="500"><div align="left"> 
               <input type="text" name="Phone" size="46" value="">
                </div>
</td>
            </tr>
            <tr> 
              <td width="130"> 
                <div align="left"><strong>Email <span style="color:#F00;">*</span>:</strong>&nbsp;</div>
              </td>
              <td width="500"><div align="left"> 
               <input type="text" name="email" size="46" value="">
                </div>
</td>
            </tr>
            <tr> 
              <td width="130"> 
                <div align="left"><strong>Date Requested <span style="color:#F00;">*</span>:</strong>&nbsp;</div>
              </td>
              <td width="500"><div align="left"> 
               <input type="text" name="ServiceDate" size="46" value="mm/dd/yyyy">
                </div>
</td>
            </tr>
            <tr> 
              <td width="130" valign="middle"> 
                <div align="left"><strong>Services Requested <span style="color:#F00;">*</span>:</strong>&nbsp;</div>
              </td>
              <td width="500"><div align="left"> 
              <textarea name="ServicesRequested" rows="10" cols="45"></textarea>
                </div>
</td>
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           <tr>
              <td><strong>Verification<br />Image:</strong></td>
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            <tr>
            <td></td>
            <td>
                  <INPUT TYPE="submit" VALUE="Submit ">
                  <INPUT TYPE="reset" VALUE="Clear">
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</form>
	
	

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				 <div style="float:left;line-height:48px" >Follow Us:</div>
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